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PI Insurance and Claims Made

claims made

Claims Made v Occurrence Wording

PI Insurance is often termed as Claims Made Insurance, and it has some peculiar traits to it.  Today we shall discuss what is Claims Made Insurance and how it relates to PI Insurance.

The following types of insurance are commonly termed Claims Made Contracts of insurance:

  • Professional Indemnity Insurance
  • Directors and Officers Liability Insurance
  • Management Liability Insurance
  • Employment Practices Liability Insurance
  • Fidelity Insurance

What is a Claims Made Contract?

Claims Made policies  only cover claims made or Known Circumstance” that you become aware could reasonably be expected to give rise to a claim that arise during the period of insurance. Acts or omissions may have occurred in a prior period and, as long as the act or omission, was after the retro-active date, the policy will extend to those prior acts.

It is essential to maintain continuity of insurance cover (no gaps in the period of cover) as claims made against you or circumstances of which you become aware could give rise to a claim, will not be covered if they are not disclosed within the period of insurance where they first arise.

If there is any claim or potential claim or even a circumstance that could reasonably be expected to give rise to a claim, it should be reported to your insurer immediately it is known, regardless of your own view as to fault. If you know of a claim or circumstance and it is not reported within the insurance period in which it arises your insurance policy is unlikely to respond.

What is a Known Circumstance?

A ‘Known Circumstance’ could be defined as any fact, situation or circumstance, which a reasonable person in the insured’s professional position would have thought, might result in someone making a claim against him/her. Therefore if a claim arises after the inception date of the policy from a fact, situation or  circumstance that the insured knew or should have known, at the time of the commencement of the policy that might give rise to a claim, it would normally be excluded as it arose from a Known Circumstance.

Why is Notifying all Known Circumstances Important?

By notifying all circumstances that might give rise to a claim, during a policy period, an insured can get the benefit of their statutory rights under Section 40(3) of the Insurance Contracts Act 1984 (the Act). Section 40(3) provides an insured with statutory rights to notify a circumstance or insured, to an insurer, during the currency of the policy.

If a claim eventuates against an insured from the notified circumstances, then the insurer cannot deny indemnity, despite the fact that the claim arose outside the period of insurance.Therefore, any fact, situation or circumstance, which a reasonable person in the insured’s professional position would have thought might result in someone making a claim against them, should be notified to their current insurer.

Changing from One Insurer to Another (Notification of Known Circumstances)

If you change insurers, you will need to notify your insurer of every conceivable circumstance before the expiry date of your policy. If this is not done, and if a claim was to occur in the future from a circumstance not previously notified, you may be left uninsured, with neither the previous or the current insurer accepting liability for the claim. The prior insurer may deny the claim as the insured failed to notify the circumstance or claim during the period of insurance.

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